三宅 仁¹, 加藤 洋¹, 小泉 克巳¹, 永澤 浩志¹, 前西 文秋², 内田 浩也², 東 貞之², 堀川 里紀², 榊原 由希², 登尾 薫²

Shinobu MIYAKE¹, Hiroshi KATO¹, Katsumi KOIZUMI¹, Hiroshi EIZAWA¹, Fumiaki MAENISHI², Hiroya UCHIDA², Sadayuki AZUMA², Riki HORIKAWA², Yuki SAKAKIBARA², Kaoru NOBORIO²

¹西神戸医療センター内科, ²西神戸医療センター同臨床検査部

¹Department of Internal Medicine, Nishi-Kobe Medical Center, ²Clinical Laboratory, Nishi-Kobe Medical Center

キーワード : Coronary vasospasm, Echocardiography, Left ventricular thrombi

A 61-year-old woman came to the emergency room because of transient left-side sensory disturbance and dysarthria that occurred suddenly after dinner on 23 January 1995. The woman had been buried alive in a house destroyed by the earthquake that had hit the Kobe area 6 days earlier. She had felt no chest pain or discomfort while trapped under the house for about 56 hours, and she had no personal or family history of angina pectoris. Echocardiography showed left ventricular wall motion abnormalities and moving thrombi, which might have caused a transient ischemic attack (TIA). The patient frequently complained of chest pain after being hospitalized, however, and treatment with nitroglycerin proved effective. Electrocardiograms showed change in ST-T after chest pain, and coronary angiography showed no remarkable stenosis before or after an ergonovine infusion test. We suspect that the pain had been caused by a spasm of the coronary artery brought on by the severe mental stress and dehydration that she experienced while buried, and that the thrombi were formed at this time. The thrombi disappeared and wall-motion abnormalities of the left ventricle improved after administration of warfarin potassium. Few cases of left ventricular thrombi after transient left ventricular wall motion abnormalities resulting from spasm of the cornary artery have been reported Transthoracic echocardiography was useful for observing disappearance of thrombi and improvement in left ventricular wall motion.